"Dear Infertility" Episode 2: Negative Pregnancy Tests

It's the end result we all dread while trying to conceive: yet *another* negative pregnancy test. Big fat negatives can make you feel like a failure, but they are definitively not your fault. In this episode of "Dear Infertility," we take real questions from real fertility patients about navigating negative pregnancy tests and share research-backed tips and strategies for how to cope. To learn more about Rescripted and to join our free fertility support community, head to our website at Rescripted.com.

Published on February 7, 2022

Rescripted _Ep2_Negative Pregnancy Tests: Audio automatically transcribed by Sonix

Rescripted _Ep2_Negative Pregnancy Tests: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Kristyn Hodgdon:
Hi, I'm Kristyn Hodgdon, an IVF mom, current IVF patient, and co-founder of Rescripted.

Ali Domar:
And I'm Dr. Ali Domar, a thirty-four-year fertility industry veteran, psychologist, and expert in the mind-body relationship between stress and infertility.

Kristyn Hodgdon:
Welcome to Dear Infertility, the first-ever podcast that doubles as an advice column for those dealing with the daily stressors related to infertility and pregnancy loss.

Ali Domar:
We're here to answer your real-life questions related to the mental and emotional toll of infertility, while providing research-backed tactics and strategies for overcoming these dilemmas.

Kristyn Hodgdon:
Now, let's dive in and help you find calm on this stressful journey.

Kristyn Hodgdon:
Hi, everyone, welcome back to the Dear Infertility podcast, I'm Kristyn, your host, and I'm here with Dr. Ali Domar. Hi, Ali.

Ali Domar:
Hey, Kristyn, how are you?

Kristyn Hodgdon:
I'm doing well. Today, we're talking about negative pregnancy tests, the dreaded big fat negative, you know that so many of us experience month after month when we're dealing with infertility. You know, we got a ton of questions from the community about this, so I'll dive right in. So one person in our community asked, I can't help but feel like my body failed me again, do you have any suggestions for coping with feelings of failure towards my body after yet another failed cycle?

Ali Domar:
So this is something that I talk about pretty much every hour during the week with my patients because they'll say I failed my cycle and I think you have to separate me or you from the cycle, because there are a thousand different reasons why a cycle may not work. It could be an age issue, it could be a sperm issue, it could be a uterine issue, it could, I mean there are a thousand different things, I mean, I was just reading a study yesterday that, you know, we really underestimate the contribution of sperm to these issues. And I remember a few years ago, I was at a conference and one of the other speakers was sort of the world expert on sperm. And he had written like seven textbooks and he was the world expert on sperm, and I think I had always thought, and you know, I'm not a physician, I'm a psychologist, that when I first started my career, I'm thinking, okay, all the sperm needs to do is fertilize the egg. And then, you know, I've obviously realized that it's a lot more than that. But what I didn't realize was that sperm can contribute not only to cycles not working, even after you see beautiful healthy blastocyst, even chromosomal normal blastocyst, but sperm contribute to early pregnancy loss and, you know, and miscarriage and preterm birth. And so I keep on telling my patients that, you know, especially if you've done, for example, a PGT cycle where you know you have a chromosomally normal embryo transfer and you know, we're assuming that your uterus is normal, it's not you who failed the cycle, it's something has not worked the way it needs to work, ideally, and it has nothing to do with you. And there's pretty much nothing you can do or not do at that point to make a cycle work. And so you kind of have to take you out of the equation.

Kristyn Hodgdon:
Yeah, that's great advice. I mean, it's hard when so much science and technology is available to us now with PGT normal embryos, it can be even tougher to digest a failed cycle because you're like, wait, I checked all the boxes, I did all the tests, I have a normal embryo, but it's still not a hundred percent, unfortunately, and sometimes it just doesn't implant, and it's not your fault.

Ali Domar:
It's definitively not your fault. I mean, you know, I remember I went to a talk at the American Society of Reproductive Medicine meeting a few years ago, and there was a symposium or a workshop or whatever by Jamie Grifo, who's the head of the NYU IVF program, and he's brilliant, he's done a ton of research on PGT, and the talk was sort of, it was PGT for dummies. I mean, it was actually entitled PGT for mental health professionals so that we could understand, and I went up to him afterwards and I said so basically in some of the best labs in the world, maybe 60 or 70 percent pregnancy rate from a PGT cycle, why aren't they all working? You know, if you're putting a chromosomally normal blastocyst into a normal looking uterus, why isn't it one hundred percent? And we just don't know.

Kristyn Hodgdon:
Right.

Ali Domar:
And could it be the sperm? Sure. Could it be the uterus? Sure. Could it be that PGT doesn't catch everything that could be wrong? Absolutely. So there's still too many unknowns. But you know, I saw a graphic the other day that in, when I got into the field, there was like a five percent pregnancy rate from IVF.

Kristyn Hodgdon:
Wow.

Ali Domar:
And now again, in a lot of centers, it's approaching 50 or 60 or 70 percent. So the progress we've made is insane. But no, we're not at 100 percent yet.

Kristyn Hodgdon:
Yeah, hopefully one day.

Ali Domar:
Hopefully one day. I mean, it's incredible. I mean, honestly, I think if, it's sort of like childhood leukemia that, you know, what, 80 years ago, pretty much every child diagnosed with leukemia would die. And nowadays I think it's probably less than, what, 10 percent? And so I do feel like it's gotten a lot better. But yeah, it's still, you know, you're throwing the dice in the air when you do an IVF cycle.

Kristyn Hodgdon:
Yeah, someone I know called it the worst kind of gamble. I definitely agree with that sentiment. So someone else wrote in asking, how do I stay positive after my last transfer resulted in a chemical pregnancy? And I can totally relate to this one, as my last transfer resulted in a chemical pregnancy, and I'm gearing up to start another cycle in January, and it's hard, I mean, I had to take a five month break after my chemical pregnancy because I just didn't feel ready to dive back in and that's, you know, that's fine.

Ali Domar:
You know, I hate the term chemical pregnancy because it makes it sound like a science experiment when in fact, as soon as you hear you're pregnant, even if the initial beta HCG is low, you're still pregnant. And so if the number doesn't double or if it goes down, which is usually the case called chemical pregnancies, I would far prefer be called an early pregnancy loss or an early miscarriage. I had a miscarriage at six or seven weeks in between my two kids and, and everyone's like, well, you know, we never saw a heartbeat, so it was not officially a clinical pregnancy, I'm like, yeah, it was a pregnancy in my mind and in my husband's mind and my family's mind. And the minute you hear you're pregnant, that's it. You start thinking names and you start, you know, you start making plans. So even if your first data was 10, you're pregnant, and honestly and truly, I actually did have a patient once whose first beta was 11, and she was told it was a chemical pregnancy, and she has a really cute little girl.

Kristyn Hodgdon:
Wow.

Ali Domar:
So there's, and there's always going to be hope.

Kristyn Hodgdon:
Yeah.

Ali Domar:
So, you know, I think these these negative pregnancy tests are extraordinarily painful, I think these chemical pregnancies, again, let's just forget that term. Let's just say it's an early pregnancy loss, which means it's a loss. But you know, from a medical perspective, it gives you a little bit of hope because anyone who gets pregnant from treatment then bumps up their prognosis. So if you do an IVF cycle and you have a early pregnancy loss or a clinical pregnancy loss or an ectopic pregnancy, your chances of getting pregnant the next cycle are higher than somebody who had just a flat zero from their pregnancy test.

Kristyn Hodgdon:
Yeah, I didn't know that until I had my early pregnancy loss, and my doctor said, although it wasn't what I wanted to hear at that moment, but she said I would rather you have had a chemical pregnancy than your transfer just not worked, but obviously again didn't want to hear that at the time. But, but that's an interesting tidbit.

Ali Domar:
It's hard, you know, it's sort of like you got towards the goal. And I think that's one of the hardest parts of this is that everyone thinks, OK, I just have to have a positive pregnancy test, yeah well, you might have a positive pregnancy test, but then they want you to come back two days later to see if it, you know, it's supposed to double every two point seven days, it's a very anxiety provoking time.

Kristyn Hodgdon:
Yeah, and I tested early this time, I don't usually, but for some reason, day seven post embryo transfer, I took a test, it was positive, took a test the next day, it was positive. So for a solid three or four days, I was pregnant and I was excited and then got a positive beta and it wasn't super low, it was like forty eight and and they said, OK, that's great, we just need to see it doubling. And so it almost prolonged the negative process.

Ali Domar:
Well, it, absolutely. And you know, and I got to tell you it's agony, because then you have to keep on coming in for blood tests until it goes down to zero. And you know, as I said, you can be a little bit pregnant and then they start worrying if it doesn't come down quickly that it could be a topic and then they have you monitored even more, so.

Kristyn Hodgdon:
Having to drive to the doctor's office knowing that your numbers are just going down is torture.

Ali Domar:
It is an absolute torture. So, you know, from a psychological point of view, you'd rather see somebody have a negative beta rather than a low positive. From a medical point of view, you want them to have a low positive, you know, because it does increase your prognosis.

Kristyn Hodgdon:
Absolutely. So a lot of community members wrote in with this question, and it's a heavy one. So how do you know when enough is enough and it's time to move on from fertility treatments?

Ali Domar:
You know, someone could actually write a book, I think there actually is a book. When is enough, enough? What I tell my patients is when you start treatment, you tend to be pretty psyched, like, especially if you're moving on to high tech. Whatever you're doing, you're like, whoa, think back to how you felt when you decided to throw away birth control and we're going to have sex and we're going to get pregnant and we're going to time it. So we're going to have sex on October 10th so that we have a baby in this month, and, you know, people do that. How naive, so many people tend to be because it takes a while to get pregnant, especially if they then go on to have infertility. So I'd say once you see a physician and once you start treatment, you know, if you have a diagnosis in the physicians like, hey, we know what it is, this is how we treat it, you tend to get pretty psyched up. And for people who do go on to do high tech treatment, when you're going to do your first IVF cycle, you should be pretty psyched because the pregnancy rates are so high. I mean, an AUI cycle has like a 10 percent per cycle pregnancy rate, and an IVF cycle could have a 50 percent per cycle pregnancy rate, so you should be pretty psyched. And so obviously then if you're super psyched with your first IVF cycle and it doesn't work, that's a huge crash. And so if you do another cycle, you might be a little less psyched because, you know, it may not work. When I see patients come to me and say, I am dreading doing this, like I have no hope, like the thought of a needle makes me nauseous, I don't want, I'm getting like PTSD from like driving past my clinic, I think that's a time to start thinking about, what do you need to do for yourself? And you know, and you can talk to your physician, you know, hopefully your physician will tell you, you're a great prognosis patient, I really think you should stick with this because I think this could work. Or your physician might say, you know what? Maybe we should have a conversation about different alternatives to what you might pursue.

Kristyn Hodgdon:
Right. Yeah, and, and I think when you're not feeling like yourself anymore, you're not doing the things that you enjoy anymore.

Ali Domar:
Right.

Kristyn Hodgdon:
I remember, you know, waking up one day and and being like, when's the last time I did this or did that that I actually enjoyed and, and it had sucked so much of the joy and life out of me for so long and you know, you have to sort of balance that with the desire to keep going and maybe it's taking a break, maybe it's stopping altogether, but there's no, it's not, it doesn't have to be black or white, like you can always start again or talk to your doctor about a different path, or you just have to take care of your mental and emotional health, however, it works for you at that moment.

Ali Domar:
I think you raise a lot of good points. I mean, you don't have to do cycle after cycle. I mean, if you're, you know, obviously if you're over 40, then time is more of an issue. But I am a huge believer in taking breaks. People want to do cycle after cycle and it can take a toll on you mentally, physically, emotionally, in terms of relationships, and yet there's also a line you don't want to cross. Like, obviously, I'm a psychologist, and so I see patients every day who are depressed or anxious or both. And then you start to worry, is their mood going to impact their chances? And so you don't want someone to cycle if they're absolutely miserable at the beginning, because then there might be an impact, and that's when you might want to take a step back and say, OK, I've lost hope, I'm feeling hopeless, I just don't know if I can do this again. And that's when you take a pause and say, what do I need to do? Do I, you know, do I ask my infertility doctor, is there a mental health professional associated with their clinic? I mean, the ASRM, the American Society of Reproductive Medicine, has this subgroup called the Mental Health Professional Group, and if you go to the ASRM website, you'll see, they're like, I don't know, four or six hundred reproductive mental health professionals across the U.S.. We started with Rescripted this new Mind-Body fertility program, which we're launching in January. It's a research based six-session remote program hopefully offered in all or most states in the U.S., where you're going to learn stress management skills and relaxation skills, and you're going to learn about the research and lifestyle habits and you're going to be with other people who get it.

Kristyn Hodgdon:
Yep.

Ali Domar:
And you know, I cannot over underestimate, I cannot emphasize enough how important it is for so many people to be with other people who understand, because I think unless your friends or family or coworkers have been through infertility, they probably are just not going to get it. And so the example I always use is someone can walk into one of the mind-body groups and say, I just learned my sister is pregnant for the third time and everyone in the group will go, oh my god, we're so sorry, which is exactly what she needs to hear, because hearing your sister is pregnant for the third time, you know, there might be a part of you happy for your sister, but there's play a bigger part of you that's really unhappy for you.

Kristyn Hodgdon:
Yeah, absolutely. I just got chills because I always say that about the Rescripted community. Like, you don't have to explain anything.

Ali Domar:
Right.

Kristyn Hodgdon:
Because everyone just gets it because they've been there at one point or another. And it's just a safe space where you can vent. And, you know, sometimes I felt too like I was explaining the science of IVF to people all the time. And you know, most people in the community kind of either are thinking about it or have been through it. And so you don't have to, I'm like egg meets sperm, and, so a lot of people also asked, how can I balance giving myself time to grieve a failed cycle with moving forward and having hope for the next cycle?

Ali Domar:
You know, it's a really good question. I think for a lot of people, it's your gut instinct. You know, I think that maybe especially with social media, we tend to look outside of ourselves for guidance on how we should think and feel and what we should do, and I'm constantly telling my patients, you know, what's your gut? Like, do you feel ready to cycle again? Do you feel like you could get psyched up to do this? And I'm like, no, like then don't, like take another month off, take me, a month or two or three is not going to dramatically impact your fertility as much as maybe a month or two or three off to nurture yourself and feed your body and soul, might put you in a much better place to do your next cycle. I mean, obviously, I'm somebody who does believe that stress might have an impact for some people on pregnancy rates, and so I don't want to see somebody starting a cycle when they're feeling depleted.

Kristyn Hodgdon:
Yeah, that's so true. When I was going through IVF the first time, I refused to take a break, I just, it was like, I was just running the marathon and, and not stopping. But this time, after the early pregnancy loss, it was just, like you said, a gut instinct, like I need to take a break, I can't be on these meds, I, they make me tired, they make me feel like not myself, and I don't want to run that marathon again this time. I just want to kind of breathe and do it when I'm ready.

Ali Domar:
You got to self.nurture. Yeah, if you know, self-nurture during this process, I mean, you might have an amazing partner and amazing family, amazing friends, but you know what you need, and you need to listen to that voice.

Kristyn Hodgdon:
Absolutely. So, you know, I always like to ask, how would you rescript the way people think about negative pregnancy tests?

Ali Domar:
Well, I probably can't use bad language on a podcast. A negative pregnancy test can be devastating. You rephrase that, a negative pregnancy test, especially after infertility treatment, is devastating. You put so much time and money and energy and effort and everything you got into this, I think you have to remind yourself it's nothing you did or didn't do. There probably was something physically going on that kept this cycle from succeeding, and you need to take really good care of yourself. And after a negative pregnancy test, you know, if you need to be in bed for three days crying, that's OK. You need to be in bed for three days crying. But you also need to, at one point sort of stop and think, what do I need? Like, what do I need right now? Do I need to go for a walk? Do I need to have a hot fudge sundae? Do I need to call my mom? Really, what do you need? And sort of your gut is going to tell you what you need. And what's really amazing is you can have a negative pregnancy test and feel awful. But don't underestimate your resilience because at some point you're going to pick yourself up. And if you don't, that's when you need to reach out for professional help. But most people just, you know, you feel terrible, awful, like you're never going to feel like yourself again. And then within a few days, like, you know what? I'm feeling encouraged, I'm feeling hopeful, you know, my doctor has a new idea, let's get back on the wagon.

Kristyn Hodgdon:
Absolutely. Well, thank you so much, Ali. This is so helpful, and we'll chat with you next time.

Ali Domar:
Thanks. Thanks, Kristyn.

Kristyn Hodgdon:
Thanks everyone for listening.

Kristyn Hodgdon:
Thank you for tuning into this episode of Dear Infertility. We hope it helps you find calm during this incredibly stressful time. Whatever you're currently struggling with, Rescripted is here to hold your hand every step of the way. If you like today's episode and want to stay up to date on our podcast, don't forget to click Subscribe. To find this episode, show notes, resources and more, head to Rescripted.com, and be sure to join our free fertility support community while you're there.

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